Comparison of thiopentone with lidocaine spray vs propofol for laryngeal mask airway insertion at tikur anbessa specialized hospital. A prospective cohort study

Abstract

Background Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery. Methods Eighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Manny Whitney test. Categorical data were analyzed by the chi-square test. A p-value ≤ 0.05 was considered a statistically significant difference. Result The comparison of data showed that a significant reduction in mean arterial blood pressure (MAP) in the Propofol group during the first 10 min. The MAP at first minute after LMA insertion was 78.4 ± 5.5 in the Propofol group compared to 81.8 ± 5.6 in thiopentone-lidocaine group p < 0.001. the mean MAP at 5th and 10th minutes after LMA insertion is also significantly lower in the Propofol group compared to the thiopentone-lidocaine group, p < 0.05. There were no statistically significant differences regarding the heart rate change and insertion conditions between the two groups. Mean apneic time was 138 ± 45.8 s in the Propofol group and 85 ± 13.8 s in thiopentone-lidocaine group p < 0.001. Thiopentone-lidocaine group had a lower treatment cost compared to the Propofol group. Conclusion Thiopentone with 10% topical Lignocaine is an alternative for the insertion of LMA to Propofol, with better hemodynamic stability and cost-effectiveness.

Effect of intranasal remifentanil Vs lidocaine on facilitation of laryngeal mask airway insertion and cardiovascular response. A double-blind clinical trial study

“…Also, in this group, we had a decrease in cough after LMA removal compared to the control group, which results are consistent with previous studies [4,17,18,19,20,22,23,24].…”

“…A standard method of induction of anesthesia for LMA placement is the use of intravenous propofol, which has the advantage of rapid induction of anesthesia with better suppression of upper airway re exes and jaw relaxation. But propofol is expensive and has more side effects (painful injection, deeper respiratory depression, longer apnea, and cardiovascular depression) than thiopental during induction of anesthesia [4]. Propofol does not have analgesic activity by itself, and if used alone, the high doses required for induction may cause cardiovascular side effects [5].…”

“…Adding a short-acting drug such as remifentanil during induction with propofol is one of the available options to reduce the amount of propofol needed, depress airway protective re exes, and facilitate LMA insertion without hemodynamic instability [3][4][5]. In particular, remifentanil has been shown to be an ideal suppressor of short-term but potent noxious stimuli, such as tracheal intubation or placement of an LMA in the airway, as it provides rapid onset of intense analgesia with a very short duration of action [6-8].…”